Cold And Flu Medication During Breastfeeding. Which Drugs Are Safe To Use?

New mothers are advised by the doctors to take as little medicine as possible during pregnancy and breastfeeding.  This is because very little is known about the safety of drugs during pregnancy and lactation, as limited research has been conducted on pregnant women.  In addition, the baby’s immune system is not fully mature at birth, thus it is not known how it will respond to the medication taken by the mother. 

Many factors affect the concentration of a drug in breastmilk

There are many complex factors that influence the concentration of a drug in breastmilk. A major factor is the drug levels in the mother’s bloodstream. It also depends on the type of drug, as some accumulate in lower amounts in the bloodstream, and subsequently in breast milk. Another factor is the ability of the drug to bind to the proteins in plasma (from the mother’s blood). Free unbound drugs quickly diffuse, while protein-bound drugs like ibuprofen diffuse in smaller amounts.  The size of the drug’s molecules matters as well. Drugs that contain alcohol, as well as caffeine and nicotine are small molecules that can quickly enter the milk. Fat-soluble drugs are also more likely to enter fat droplets in the milk. Finally, how the mother metabolizes the drug- based on genetics and other factors- plays an important role, as well. Some women are “ultra-rapid metabolizers’ ‘. If they take codeine, for example, the baby may experience significant depression of the nervous system, potentially even death.                                            

Factors that increase the risk of adverse reactions in baby 

If the baby is exposed to a drug during breastfeeding, there are also several factors that influence how the baby may respond. The timing of breastfeeding is important, and feeling right before taking a drug will typically translate into the lower concentration of the drug in the breast milk.                                                                                              

Premature babies and newborns have a lower ability to metabolize a drug and therefore are at higher risk to develop side effects from a drug taken by the mother. On the other hand, babies that are six months or older have an increased ability to metabolize the medicine. The amount of milk a baby receives also matters and babies who are exclusively breastfed are more exposed to a drug compared to an older baby who is breastfed rarely and in small amounts.                                

What can you take for a cold or flu while breastfeeding?

Use safe home remedies before trying to take any medication. Mild symptoms of colds and flu-like nasal congestion, sore, scratchy throat, and cough can improve with hot teas with honey and lemon, warm broth, juices, and chicken soup. Gargling warm water with salt also helps. Generally speaking, acetaminophen, dextromethorphan, guaifenesin, and ibuprofen could be used but it is best to talk to a doctor before using any over-the-counter or prescription medications.

What drugs should you avoid during breastfeeding?

As mentioned above, codeine should not be used during lactation. Use safer alternatives like ibuprofen or paracetamol instead. 

Avoid sprays or lozenges that contain povidone-iodine. Iodine can accumulate in the breast and depress the thyroid function in babies. 

Avoid cough and cold medication based on alcohol- they can cause drowsiness and other side effects in the baby. 

Avoid cough and cold formulas that contain multiple active ingredients. It is easy to overdose on them, especially when taking other drugs too. In addition, some formulas contain codeine.

Other drugs that should be avoided during breastfeeding include medications containing phenylephrine and pseudoephedrine. These drugs can lower the amount of breastmilk, as well. Aspirin increases the risk of Reye’s syndrome and potent drugs used for other conditions like cancer drugs and certain immunosuppressants should also be avoided. Sulphasalazine, acid blockers like cimetidine, and the antibiotic tetracycline should not be used during breastfeeding. 

Additional ways to limit your baby’s exposure to medicine (and your illness) 

If you need to take medicine, work around the breastfeeding schedule. Feed your baby before taking the drug, and avoid feeding again for another couple of hours after taking a drug. 

Some cold and flu drugs can be taken in extra strength doses only once a day, rather than taking multiple doses in the regular strength. However, keep in mind that these drugs are stronger and will also stay for longer in the blood and possibly in the milk. Thus, avoid feeding for more than a few hours after taking them.

To avoid spreading the infection to your baby, make sure you wash your hands more often, especially before touching your baby.  Wash your clothes more often, and avoid sharing a blanket with your baby. A facemask during breastfeeding may also help protect your baby. 

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